Prevalence, Characteristics, and Reasons for Kratom Use among Psychiatrically Ill Inpatients Who Use Substances.

OBJECTIVE: Despite kratom impacting neurobiological systems involved in psychiatric disorders, little is known about the prevalence of use among patients with severe psychopathologies. Here, we investigated the prevalence of kratom use, motives for use, and the clinical associations among inpatients with severe psychiatric disorders. METHODS: A total of 578 patients, aged 18 to 65, were evaluated by New Hampshire Hospital's Addiction Services from January 1, 2020, to February 28, 2022. The study collected demographic information and used chi-square tests, multivariable logistic regression, and subgroup analyses with 95% confidence intervals to examine trends among kratom users. A receiver operating characteristic curve analysis was also conducted. All statistical tests were performed using IBM SPSS Version 28.0.1. RESULTS: Of the patients assessed, 2.2% (n = 13) reported using kratom. The reasons for kratom use were managing withdrawal symptoms (15.4%), maintaining sobriety and reducing cravings for opioids (53.8%), improving focus and concentration (30.8%), alleviating low moods (38.5%), and managing pain (15.4%). Compared to non-kratom users, the only factor with a fair to good association with kratom use is postsecondary education (Area Under Curve, AUC = 0.77). CONCLUSIONS: Prevalence of kratom use among patients with serious mental illness at our site aligns with that reported in the general population. Users often cite self-management of cravings and sobriety from opioids, as well as treatment of low mood states, as motivations for consumption. While observations suggest a possible association between kratom use and individuals with post-secondary education, multiple substance use, and experience of substance-induced psychosis or mood disorders, it is essential to interpret these links cautiously until further rigorous studies are carried out to substantiate these findings.

Land use and land cover changes implications on biodiversity in the Owabi catchment of Atwima Nwabiagya North District, Ghana.

This paper examined land use and land cover (LULC) change and implications to biodiversity in the Owabi catchment of Atwima Nwabiagya North District in Ghana from 1991 to 2021 using remote sensing, and geographic information systems (GIS), with participatory methods such as interviews and questionnaires with a sample size of 200 participants. The use of supervised classification with maximum likelihood algorithm in QGIS was employed to generate LULC maps of 1991, 2001, 2011, and 2021. Molusce Plugin in QGIS was applied to predict probabilities of LULC changes in 10 years (2021-2031). The results showed that high-density forest has disappeared from 1991 to 2021 while built-up has increased and remained the most dominant LULC from 2011 to 2021. There is a continual decline in the number of plant and animal species in and around the Owabi catchment. This can be attributed to the decline of high-density forests and increased built-up in the study area through human actions. The study identified the influence of human activities as the key forces of LULC change to biodiversity loss. This problem stemmed from the taste for housing and trading activities in the Kumasi Metropolitan Area which has resulted in an increasing demand for settlement because of its closeness to Kumasi and its environs. The study recommends that stringent preventive measures should be developed and enforced by various stakeholders including the Forestry Commission, Ghana Water Company Limited, Environmental Protection Agency, as well as the District/Municipal Assemblies to safeguard the forest from human activities. This recommendation will help these agencies to keep abreast with changes in LULC in the various communities and factors such as changes during the planning of the communities.

Psychiatric Boarding in Emergency Departments and the COVID-19 First Wave: The New Hampshire Response.

The COVID-19 pandemic forced unprecedented challenges for emergency department operations during the spring of 2020. Before the COVID-19 pandemic, psychiatric boarding in emergency departments required a substantial amount of staffing and administrative resources. This case study describes one state's efforts to rapidly decrease psychiatric boarding by 93% in 2 weeks with a multipronged approach, and simultaneously minimal effects observed on outcome measures of psychiatric hospital readmissions and suicide rates. Lessons learned are discussed regarding workflow adaptations and leadership implications.

Evaluating health information provided to kratom consumers by good manufacturing practice-qualified vendors.

BACKGROUND: "Kratom" commonly refers to the botanical Mitragyna speciosa, native to Southeast Asia, which is increasingly used globally for its unique pharmacological effects. Motives for using the whole plant material or kratom-derived products include self-management of pain, mental health disorders, symptoms related to substance use disorders, and/or to increase energy. In the United States, kratom products have varying alkaloid content, potencies, and marketing profiles. There is little regulatory oversight over kratom, as it is currently not approved as a dietary supplement by the Food and Drug Administration. This results in substantial variability in labeling of kratom products and the product information provided to consumers. METHODS: In January 2023, we evaluated the American Kratom Association's Good Manufacturing Practices (GMP) qualified vendors' websites (n = 42) using the well-established and validated DISCERN instrument to examine the quality of health information provided to consumers. DISCERN contains 15 five-point Likert-scale questions on specific criteria, with the highest possible score being 75, indicating that all the DISCERN criteria have been fulfilled by the website (i.e., the highest quality information is provided to consumers). RESULTS: The mean DISCERN score for all evaluated online kratom vendors was 32.72 (SD = 6.69; score range 18.00-43.76). Overall, vendors scored higher on DISCERN questions assessing the website's reliability, as vendors typically provided clear information for consumers about product availability, purchasing, shipping, etc. On average, vendors scored poorly on the DISCERN section pertaining to the quality of the health information provided. Information on kratom's potential risks and benefits was particularly insufficient. CONCLUSIONS: Consumers require high quality information in order to make informed decisions concerning use, which entails disclosure of known risks and potential benefits. The online kratom vendors evaluated in this study should consider enhancing the quality of health information provided, especially information regarding kratom's risks and benefits. Further, consumers should be made aware of current knowledge gaps related to kratom's effects. Clinicians must also be aware of the lack of evidence-based information available to their patients who use kratom or are interested in using kratom products, in order to facilitate educational discussions with them.

Cyanide contamination assessment via target survey and physicochemical and bacteriological characterization: a case study of Akrofrom-Techiman cassava processing area in Ghana.

Improper discharge of cassava mill effluent (CME) has attracted much attention in major cassava-producing areas due to cyanide contamination. This study conducted a target survey on inhabitants and processors of the Akrofrom-Techiman cassava processing area in Ghana that aimed to assess their knowledge and perception of cyanide contamination from the CME discharge. The study further examined the effect of CME on the soil and groundwater at the processing area using physicochemical and bacteriological characterizations. Results revealed that inhabitants and processors exhibited high illiteracy on the impact of CME on cyanide contamination in the processing area. The study also indicated a wide characteristics of the soil at the processing site: pH (4.89-8.77), electrical conductivity (EC) (1063.00-1939.00 µS/cm), total dissolved solids (TDS) (523.90-963.50 mg/L), soil moisture (11.90-31.70%), free cyanide (0.02-0.33 mg/kg), and total cyanide (0.40-2.70 mg/kg). Results also showed that the physicochemical values of the CME were all above the Ghana Environmental Protection Agency (EPA) permissible limits and were unsafe for discharging into the environment. The range of physicochemical and bacteriological parameters of the two boreholes revealed the following: pH (7.85-8.74), TDS (165.77-192.37 mg/L), EC (320.87-396.20 µS/cm), free cyanide (0.13-0.16 mg/L), total cyanide (1.29-2.15 mg/L), and bacteriological parameter (220-622 cfu/mL). The two hand-dug wells also recorded pH (8.54-9.56), TDS (140.77-156.10 mg/L), EC (288.53-340.67), biological oxygen demand (BOD) (21.51-1.61 mg/L), chemical oxygen demand (COD) (13.5-16.5 mg/L), free cyanide (0.10-0.11 mg/L), bacteriological parameter (241-302 cfu/mL), and total cyanide (0.79-0.86 mg/L). The study concluded that the discharge of CME at the processing site contributes significantly to cyanide contamination of the soil and groundwater at the processing area.

A Thematic Analysis of Overdose Prevention and Response Efforts in States Experiencing Declines in Rates of Opioid-Involved Overdose Deaths.

OBJECTIVE: To address the opioid overdose epidemic, it is important to understand the broad scope of efforts under way in states, particularly states in which the rate of opioid-involved overdose deaths is declining. The primary objective of this study was to examine core elements of overdose prevention activities in 4 states with a high rate of opioid-involved overdose deaths that experienced a decrease in opioid-involved overdose deaths from 2016 to 2017. METHODS: We identified 5 states experiencing decreases in age-adjusted mortality rates for opioid-involved overdoses from 2016 to 2017 and examined their overdose prevention programs via program narratives developed with collaborators from each state's overdose prevention program. These program narratives used 10 predetermined categories to organize activities: legislative policies; strategic planning; data access, capacity, and dissemination; capacity building; public-facing resources (eg, web-based dashboards); training resources; enhancements and improvements to prescription drug monitoring programs; linkage to care; treatment; and community-focused initiatives. Using qualitative thematic analysis techniques, core elements and context-specific activities emerged. RESULTS: In the predetermined categories of programmatic activities, we identified the following core elements of overdose prevention and response: comprehensive state policies; strategic planning; local engagement; data access, capacity, and dissemination; training of professional audiences (eg, prescribers); treatment infrastructure; and harm reduction. CONCLUSIONS: The identification of core elements and context-specific activities underscores the importance of implementation and adaptation of evidence-based prevention strategies, interdisciplinary partnerships, and collaborations to address opioid overdose. Further evaluation of these state programs and other overdose prevention efforts in states where mortality rates for opioid-involved overdoses declined should focus on impact, optimal timing, and combinations of program activities during the life span of an overdose prevention program.

Spatial variation in lymphatic filariasis risk factors of hotspot zones in Ghana.

BACKGROUND: Lymphatic Filariasis (LF), a parasitic nematode infection, poses a huge economic burden to affected countries. LF endemicity is localized and its prevalence is spatially heterogeneous. In Ghana, there exists differences in LF prevalence and multiplicity of symptoms in the country's northern and southern parts. Species distribution models (SDMs) have been utilized to explore the suite of risk factors that influence the transmission of LF in these geographically distinct regions. METHODS: Presence-absence records of microfilaria (mf) cases were stratified into northern and southern zones and used to run SDMs, while climate, socioeconomic, and land cover variables provided explanatory information. Generalized Linear Model (GLM), Generalized Boosted Model (GBM), Artificial Neural Network (ANN), Surface Range Envelope (SRE), Multivariate Adaptive Regression Splines (MARS), and Random Forests (RF) algorithms were run for both study zones and also for the entire country for comparison. RESULTS: Best model quality was obtained with RF and GBM algorithms with the highest Area under the Curve (AUC) of 0.98 and 0.95, respectively. The models predicted high suitable environments for LF transmission in the short grass savanna (northern) and coastal (southern) areas of Ghana. Mainly, land cover and socioeconomic variables such as proximity to inland water bodies and population density uniquely influenced LF transmission in the south. At the same time, poor housing was a distinctive risk factor in the north. Precipitation, temperature, slope, and poverty were common risk factors but with subtle variations in response values, which were confirmed by the countrywide model. CONCLUSIONS: This study has demonstrated that different variable combinations influence the occurrence of lymphatic filariasis in northern and southern Ghana. Thus, an understanding of the geographic distinctness in risk factors is required to inform on the development of area-specific transmission control systems towards LF elimination in Ghana and internationally.

Precipitable Water Vapour Retrieval from GPS Precise Point Positioning and NCEP CFSv2 Dataset during Typhoon Events.

Radiosonde is extensively used for understanding meteorological parameters in the vertical direction. Four typhoon events, including three landfalls (MERANTI, NEPARTAK, and MEGI) and one non-landfall (MALAKAS), were chosen in analysing the precipitable water vapour (PWV) characteristics in this study. The spatial distribution of the three radiosonde stations in Zhejiang province does not meet the requirement in analysing changes in PWV during typhoon event. Global position system (GPS) observations are an alternative method for deriving the PWV. This enables improvements in the temporal⁻spatial resolution of PWV computed by the radiosonde measurements. The National Centers for Environmental Prediction (NCEP) re-analysed data were employed for interpolating temperature and atmosphere pressure at the GPS antennas height. The PWV computed from GPS observations and NCEP re-analysed data were then compared with the true PWV. The maximum difference of radiosonde and GPS PWV was not more than 30 mm at Taiz station. The Root-Mean-Square (RMS) of PWV differences between radiosonde and GPS was not more than 5 mm in January, February, March, November, and December. It was slightly greater than 5 mm in April. High RMS in May, June, July, August, September, and October implies that differences in GPS and radiosonde PWVs are evident in these months. Correlation coefficients of GPS and radiosonde PWVs were more than 0.9, indicating that the changes in GPS and radiosonde PWVs are similar. Radiosonde calculated PWVs were used for GPS PWV calibration for understanding the PWV changes during the period of a typhoon event. The results from three landfall typhoons show that the average PWV over Zhejiang province is increasing and approaching China mainland. In contrast, MALAKAS did not make landfall and shows a decreasing PWV trend, although it was heading to China mainland. Generally, the PWV change can be used to predict whether the typhoon will make landfall in these cases. PWV spatial distribution of MERANTI shows that PWV peaks change along the typhoon epicenter over Zhejiang province.

Hepatitis A Virus Outbreaks Associated with Drug Use and Homelessness - California, Kentucky, Michigan, and Utah, 2017.

During 2017, CDC received 1,521 reports of acute hepatitis A virus (HAV) infections from California, Kentucky, Michigan, and Utah; the majority of infections were among persons reporting injection or noninjection drug use or homelessness. Investigations conducted by local and state health departments indicated that direct person-to-person transmission of HAV infections was occurring, differing from other recent, large HAV outbreaks attributed to consumption of contaminated commercial food products. Outbreaks with direct HAV transmission among persons reporting drug use or homelessness signals a shift in HAV infection epidemiology in the United States, and vaccination of these populations at high risk can prevent future outbreaks.

Effect of Ambulatory Transitional Care Management on 30-Day Readmission Rates.

A process improvement initiative for transitional care management (TCM) was evaluated for effectiveness in reducing 30-day readmission rates in a retrospective cohort study. Regression models analyzed the association between level of TCM component implementation and readmission rates among patients discharged from a university medical center hospital. Of the 1884 patients meeting inclusion criteria, only 3.7% (70) experienced a 30-day readmission. Patients receiving the full complement of TCM had 86.6% decreased odds of readmission compared with patients who did not receive TCM ( P < .001). However, the complete package of TCM services under Medicare guidelines may not be essential. A postdischarge telephone call did not reduce readmission odds, provided a TCM office visit occurred. Important for risk assessment models targeting patients for TCM, the number of previous hospital admissions, not age, predicted 30-day readmission risk. This study provides evidence that primary care-based TCM can reduce 30-day readmissions even when overall rates are low.

Analysis of climate and anthropogenic impacts on runoff in the Lower Pra River Basin of Ghana.

The Lower Pra River Basin (LPRB), located in the forest zone of southern Ghana has experienced changes due to variability in precipitation and diverse anthropogenic activities. Therefore, to maintain the functions of the ecosystem for water resources management, planning and sustainable development, it is important to differentiate the impacts of precipitation variability and anthropogenic activities on stream flow changes. We investigated the variability in runoff and quantified the contributions of precipitation and anthropogenic activities on runoff at the LPRB. Analysis of the precipitation-runoff for the period 1970-2010 revealed breakpoints in 1986, 2000, 2004 and 2010 in the LPRB. The periods influenced by anthropogenic activities were categorized into three periods 1987-2000, 2001-2004 and 2005-2010, revealing a decrease in runoff during 1987-2000 and an increase in runoff during 2001-2004 and 2005-2010. Assessment of monthly, seasonal and annual runoff depicted a significant increasing trend in the runoff time series during the dry season. Generally, runoff increased at a rate of 9.98 × 107m3yr-1, with precipitation variability and human activities contributing 17.4% and 82.3% respectively. The dominant small scale alluvial gold mining activity significantly contributes to the net runoff variability in LPRB.

Systematic Review of Ambulatory Transitional Care Management (TCM) Visits on Hospital 30-Day Readmission Rates.

To reduce readmission rates and prevent adverse outcomes after discharge, hospitals have begun implementing "transitional care" initiatives. This systematic review identifies research on the particular set of services now reimbursable by Medicare (transitional care management [TCM]) and evaluates the studies for program effectiveness. Results of 3 databases were screened for peer-reviewed journal articles published between January 2004 and 2015 that report on readmissions of adults in the US health care system under the Medicare TCM bundle. ClinicalTrials.gov was queried for funded studies. Of 969 identified studies, 77 met inclusion criteria for relevance to transitional care and appropriateness of population and setting. Of these, only 3 articles incorporated all required elements for TCM service. Although 2 were program improvement designs and none were randomized controlled studies, each report reduced readmission rates. Evidence for TCM effectiveness is limited. Additional study of TCM implementation and programmatic support for TCM is warranted.

Modelling population growth on public water and sanitation facilities using GIS and statistics: a case study of Aboabo, Ghana.

BACKGROUND: Effect of population increase on public water and sanitation facilities in densely populated area, Aboabo, Kumasi, Ghana. MATERIALS AND METHODS: Town sheet maps, layout and population census data of Aboabo. GPS for observing spatial locations existing water and sanitation facilities and field verification exercise in the study. GIS for building geodatabase, digitization and Cartographic Visualization. Questionnaires were used to collect non-spatial information on the sanitation facilities and all public facilities. RESULTS: GIS and a Statistical Approach have been respectively used to develop cartographic and mathematical models to analyse, predict and visualize the effect of population increase on public water and sewage facilities in densely populated area. The developed mathematical models correlates with the population at each instance to the required number of water accessible points or standing pipes as well as the number of required public toilet (sewage) facilities. The cartographic and mathematical models provides an efficient and effective means of mitigating diseases associated with water and sanitation; and informs planners and assembly members of the effects of increasing population on public facilities for proper future planning and geospatial decision making; and to ensure proper infrastructural management at the community levels. CONCLUSIONS: Effective decision support systems for analysing, predicting and visualizing public water and sewage facilities in densely populated area. Draws the awareness of the government, concerned groups and non-Governmental Organizations (NGO's) to the extreme detrimental effect that the increase in population has, especially on public water and sewage facilities and how it can be managed at the community level.